Create national specialised referral hospital based on digital health technology

In Summary

•I proposed this idea in 2008 to spearhead such an initiative under our NHIF then.

•My concern was with the number of cancer cases that showed a tendency to increase exponentially into the future while both facilities and specialists were terribly lacking.

Universal Health Coverage
Universal Health Coverage

The "UHC Trial Runs" or "Pilots" in the four counties of Nyeri, Machakos, Isiolo and Kisumu have taught us some important lessons that we need to share with Kenyans as we roll out Universal Healthcare Coverage nationally.

One of the lessons is based on what economists call "efficiency gains". That is, using what you already have more cost-effectively to maximise on the gains or outcome without necessarily incurring any extra cost - or even by getting more while spending less. I am sure we understand each other on that.

Take, for example, our so-called perennial shortage of human resources in delivering health care. We complain of not having enough doctors, nurses and specialists such as oncologists, cardiologists, etc. How about if we used the medical personnel we already have to do things they are not doing now, hence cut down on what we currently assume is a shortage? 

Before I explain how that can be done, let me pose yet another question. How about if we used "Labour Saving Devices", i.e. technology, to access special services at a cost much lower than we would have incurred were we to use actual human labour?

On the first issue, I would like to request the reader to take a mental count of the number of Kenya Medical Training Colleges we have in the country. It is safe to assume that we have at least one KMTC per county: That makes them 47. In Kisumu, we have two, and thus the total number could easily reach 50.

Recollect that faith-based organisations and other private hospitals also train nurses, lab technicians and clinical officers. This adds to the number of healthcare "apprentices" that are trained at that level in our country. 

I want to propose that the government adds to the requirement of anybody qualifying as a health practitioner at this level that one must serve in a dispensary, health centre or sub-county hospital for at least six months before graduation. This "apprentice internship", as a prequalified "nurse, clinical officer, lab technician or pharmacist" will be based on a successful performance understand a registered supervisor.

By this move, we shall substantially reduce on what we currently take as a shortage of nurses by getting people "ready to be nurses" practising their knowledge as apprentices under a "master nurse, clinical officer or doctor." I will leave the fine details to the people in the profession to work on.

Likewise, I would like to propose that students doing their third or fourth year in medical schools, whether public or private, should take six months to work in health centres, sub-county hospitals and county hospitals as "apprentice physician assistants" so as to get practical experience on what they are learning in lecture rooms. At the same time they will help us reduce the so-called shortage of human resources in our health delivery system. 

People training as blacksmiths have been using this kind of system in doing business while training for a long time. University hospitals the world over, including Aga Khan University Hospital here in Kenya, make full use of their students to deliver services as part of their training. Why are we underutilising our training facilities and universities as governments  (national and county)?

Let me now address the issue of efficiency gains using medical technology under what is currently known as telemedicine.

We laud telemedicine for the efficiency and cost saving it can introduce in our health delivery system yet we have been very slow in implementing and utilising basic things like Electronic Patient Records (EPR) in our health facilities. I recommend to the President a very urgent Executive Order that ALL  health facilities, private or public, must implement EPR  by December 2020. 

Secondly, to make effective use of our EPR information for diagnosis and treatment from one facility to the other nationally and internationally, we need to improve real-time communication and data flow in our ICT regime. This requires leapfrogging into the era of 5G technology. China has done it and here is the story as reported in a recent issue of China Daily newspaper. 

In April, a patient suffering from heart disease in Gaozhou, Guangdong province, was saved through remote surgery that was supported by 5G technology. 

During the procedure, which lasted about three hours, a surgeon in Gaozhou Hospital wore a probe that transmitted ultra-high definition pictures to a display at a top hospital 400 kilometres away in Guangzhou, where experts used 5G live streaming to give real-time instructions to the surgeon.

Many more such examples exist in China today.  China,  as reported by China Daily,  has leapfrogged other countries in adoption of digital health technology based on a survey of more than 15,000 individuals and over 3,100 healthcare professionals in 15 countries, including the USA, the UK, Australia and France.

Ninety-four per cent of Chinese health professionals have reported using digital health technology or mobile health apps. Likewise India reports 88 per cent and Saudi Arabia 85 per cent. Kenya does not feature anywhere notwithstanding our very ambitious and laudable attempts to implement UHC. We have a lot to gain from going fully digital the 5G way.

If we do this, and our State Department of ICT should lead us as of yesterday, we shall drastically reduce our dependence on going abroad for specialised treatment. We will only need  specialised local referral facilities where our own doctors will collaborate with their counterparts abroad to undertake appropriate diagnosis and treatment on a case by case basis.

I had proposed the creation of one national specialised referral hospital in Kenya in 2008 to spearhead such an initiative under our NHIF then. My concern was with the number of cancer cases that showed a tendency to increase exponentially into the future while both facilities and specialists were terribly lacking.

 The proposal was shot down by my colleagues in government arguing that we needed to invest in basic health facilities for the time being. I propose that we urgently do both at the same time since life must be saved at both higher and lower levels of healthcare delivery.